Abstract
Digital morphology (DM) analyzers are widely applied in clinical practice. It is necessary to evaluate performances of DM analyzers by focusing on leukopenic samples. We evaluated the analytical performance, including precision, of a Sysmex DI-60 system (Sysmex, Kobe, Japan) on white blood cell (WBC) differentials in leukopenic samples. In a total of 40 peripheral blood smears divided into four groups according to WBC count (normal, mild, moderate, and severe leukopenia; each group n = 10), we evaluated precision of WBC preclassificaiton by DI-60. %coefficients of variation (%CVs) of precision varied for each sample and for each cell class; the fewer cells per slide, the higher %CV. The overall specificity and efficiency were high for all cell classes except plasma cells (95.9–99.9% and 90.0–99.4%, respectively). The largest absolute value of mean difference between DI-60 and manual count in each group was: 10.77, normal; 10.22, mild leukopenia; 19.09, moderate leukopenia; 47.74, severe leukopenia. This is the first study that evaluated the analytical performance of DI-60 on WBC differentials in leukopenic samples as the main subject. DI-60 showed significantly different performance depending on WBC count. DM analyzers should be evaluated separately in leukopenic samples, even if the overall performance was acceptable.
Highlights
Following the complete blood count (CBC), peripheral blood smear (PBS) examination performed by light microscopy is the second most common test in hematology laboratories [2,3]
We aimed to evaluate the performance of DI-60 on white blood cell (WBC) differentials, especially precision according to the Clinical and Laboratory Standards
With the setting of 210 WBC counting, 222.5 cells (IQR, 79–231.5 cells) per slide were counted by DI-60 in a total of 40 samples, and less than 210 cells per slide in 15 samples. 200 cells (IQR, 133.5–200 cells) per slide were counted by manual count in total samples, and less than 200 cells per slide in 11 samples
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Morphological analysis of peripheral blood smear (PBS) is mandatory for diagnosing hematologic diseases [1]. Following the complete blood count (CBC), PBS examination performed by light microscopy is the second most common test in hematology laboratories [2,3]. The white blood cell (WBC) differential on PBS is performed by the manual count, which two hematology experts count 200 cells each [4]. The manual count is still the gold standard method, it is time-/labor-intensive and subjective with large inter/intra-observer variation and requires skilled observers who are trained continuously [1,5]
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